Healthcare Provider Details

I. General information

NPI: 1609590140
Provider Name (Legal Business Name): JENNIFER LEE BISHARA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 10/30/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W DRY CREEK CIR
LITTLETON CO
80120-4478
US

IV. Provider business mailing address

20 W DRY CREEK CIR
LITTLETON CO
80120-4478
US

V. Phone/Fax

Practice location:
  • Phone: 303-703-8583
  • Fax:
Mailing address:
  • Phone: 303-703-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0998058-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: